The Justices Should See ‘What It’s Like’

June 19, 2012

“They’re not in the real world. They’re up in Washington with their private insurance. They should come down in the sticks and the foxholes, and see what it’s like.” — Dr. Matthew Petrilla, primary care physician at a clinic in rural Tennessee.

The quote above comes from an article written by my colleague Alec MacGillis and produced in conjunction with Kaiser Health News. If you haven't read the article already, you really should.

Petrilla, an army veteran, is talking about the justices of the Supreme Court—and the possibility that they might, as early as Monday morning, issue a decision overturning part or all of the Affordable Care Act. I know how he feels.

During oral arguments in March, the conservative justices most likely to rule against the law spent a lot of time talking about possible infringements of liberty and posing hypotheticals about a broccoli mandate. Although that line of argument seems no more persuasive to me now than it did the first time I heard it, I appreciate and share the justices’ determination to protect personal freedom.

But those same justices betrayed no sense that the law might exist for a reason—that Congress had tried, however imperfectly, to address a very real crisis with very real human costs; that, for tens of thousands of Americans every year, if not more, the Affordable Care Act will likely mean the difference between financial solvency and bankruptcy or maybe even life and death. Those facts don't give Congress the right to violate the Constitution, if the justices truly believe that's what the mandate does. But those facts should give the justices pause, as they contemplate a ruling and its implications—and whether the individual mandate is a “necessary and proper” method of regulating the insurance market.

Of course, the justices aren’t the only people who seem unaware of the law’s impact. The saddest part of Alec’s article was his interview with a mother of two who came to the clinic seeking care for her serious medical problems. “What new law?” she asked when Alec queried her about the Affordable Care Act. “I’ve not heard anything about that.” As Greg Sargent points out, the polls show such sentiments are common. These people may come to appreciate the law after 2014, once it takes full effect—but only if the Supreme Court lets that happen.